Ending the TB epidemic

Dr Amitava Acharyya, CNS Correspondent, IndiaTB which finds mention in Indian ancient texts, seems to be as old Indian civilization. In Ayurveda, it is included in “Sosha” group of diseases. These are diseases with a prominent feature of wasting, and there are other symptoms such as cough and blood-spitting. According to Indian mythology the Moon-god, was the first to become a victim of TB, and so the disease is also known as Rajayakshma—the king’s disease.
Way back in 1933, Major General Sir John Megaw, Director General of the Indian Medical Services, had estimated about 2 million cases of TB in India at that time. He had noted that, “TB is evidently very widespread throughout the villages of India, but is specially serious in Bengal, Madras (now Tamil Nadu), Punjab, Bihar and Orissa. Pulmonary TB seems to be much more common than extra pulmonary TB, except in the United Provinces and Bombay.” The National TB Control Project (NTCP) was launched in India in 1962. Since then, India has achieved many improvements in this sector, but many problems still persist. India bears an unfair burden of TB—it has 17% of the global population and 26% of global TB. A decade ago we were 16% of global population with 20% of global TB. This disproportionate increase reflects, among other things, poor TB control in India. The problem is further compounded by the rise of drug resistant strains of TB in recent years.

The vision of the ‘End TB Strategy’ of the Global TB Programme of World Health Organization (WHO) is a world free of TB. Its goal is to end the global TB epidemic and it targets a 95% reduction in the number of TB deaths and a 90% reduction in TB incidence rate by 2035 as compared with 2015. In a webinar organised by CNS and the International Union Against Tuberculosis and Lung Disease, Dr Mario Raviglione, Director of the Global TB programme, presented his views on the future action plan to deal with the burden of TB. He spoke about the 3 pillars and the 4 principles on which this strategy is based. The first pillar is related to integrated patient-centred TB care and prevention; having bold and supportive policies is the second pillar; and the third one is related to intensified research and innovation.

Dr Raviglione called for 6 priorities actions to achieve this. These are related to (i) ensuring diagnosis and quality care for the ‘missed cases’, (ii) addressing the crisis of MDR-TB, (iii) accelerating response to TB-HIV co-infection, (iv) addressing TB with universal health coverage and social protection agendas, (v) intensifying research and innovations, and (vi) increasing financing to close resource gaps. Protecting and promoting human rights, ethics and equity is very important. I have personally seen TB patients face stigma within their families, and in their social and professional lives. Creating awareness about TB among common people, providing TB patients with social and financial support along with quality treatment could minimize this dilemma.

Last, but not the least, is research and development to find better anti TB drugs and eventually a vaccine for TB. We know that currently treatment of multi drug resistant TB (MDR-TB) is very painful and of a long duration, not to talk of the severe side effects. This often affects treatment compliance. There are two new drugs in the market—Bedaquiline and Delamanid—for difficult to treat drug resistant strains of TB. But they are very highly priced and, as of now, out of reach of those who need them. Meanwhile, the Union is collaborating with other agencies on an ongoing research project named STREAM, which is focussed on shortening of treatment regimens for MDR-TB. If this project is successful, it will be a huge gift for MDR-TB patients.